Contemporary Issues in Medical Informatics: Good Health IT, Bad Health IT, and Common Examples of Healthcare IT Difficulties
Muddled thinking: a major cause of healthcare's dangerous lag in Y2K remediation

Muddled thinking: a major cause of healthcare's dangerous lag in Y2K remediation

An overworked, understaffed hospital MIS department suffering from generally low morale was trying to gear up to fix the organization's Y2K problems, well-aware of the berating being done by the government (e.g., Sen. Dodd of the special Senate Subcommittee on Y2K) about the unpreparedness and liability in healthcare.

An informaticist who was concerned about the MIS department's ability to handle this challenge alone suggested at a meeting that bringing in an IT consulting company such as CSC, EDS, or the like who've formed Y2K divisions would be very prudent. Several industry senior CIO's also acting as consultants in IT to the organization agreed with this at the meeting. The response from the senior executive overseeing MIS in this hospital (himself having no background in information technology whatsoever) was that "We know how to handle these things best ourselves, consultants will only slow us down" and "I'm not enthusiastic about fixing the Y2K problem, since it will utilize resources and detract from our mission to serve the community." (?!?)

The top executives were informed by the informaticist that such attitudes were potentially reckless or even catastrophic in view of dire, almost daily warnings from many sources about healthcare's unpreparedness in Y2K, risk to the community, liability that could extend into the hundreds of billions of dollars, and other factors. The informaticist also told them of a number of "train wrecks" he'd personally seen that occurred due to similar attitudes. Somewhat like noncompliant patients ignoring a physician's expert advice, however, the top executives were concerned mainly about whether the "proper process" had occurred at the meeting and did not revisit the meeting's decisions, e.g., concerning Y2K consultants.

The Ivy League-trained informaticist was frightened by the disdain of the leadership towards such matters. Further, the informaticist realized that there was a literal abyss between the thinking in informatics about rigor, science, and best engineering practices, and the cavalier thinking of this organization's management towards information technology. The informaticist left this organization shortly thereafter.

Many months later, this organization now finds itself so starved for resources and scrambling to accomplish Y2K remediation by itself, that virtually all other computing projects, especially clinical computing projects serving clinician's needs, have been halted or postponed. Even minor improvements to existing clinical applications have been stopped so that "MIS can devote all its efforts to Y2K." In an unfortunate illustration of cascading dangers that occur when critical healthcare IT issues are mismanaged by technology-unlettered executives, clinicians at this organization no longer have expert informatics assistance, their clinical IT projects have lost significant momentum and have been marginalized, and their needs are being neglected.

Needless to say, all of this has not helped the morale and image of the MIS department.

The company that produces this organization's HIS (hospital information system) and other critical information systems has just been sued for securities fraud involving the misreporting of finances. The company has also been named as defendant in a multitude of shareholder class-action lawsuits. This may diminish the company's ability to assist its clients with its HIS and other information systems.

It should probably be noted that the people responsible for the financial problems at the company are business and financial people, the same occupational background as those at this hospital who decided to ignore the informaticist on bringing in outside help on Y2K remediation as early as possible. (The informaticist believed in a rigorous approach to critical, unpredictable problems such as Y2K, and in optimizing resources to guard against unexpected contingencies.) The scenario just mentioned could have become a spectacular example all-around of the wrong people making the wrong decisions for healthcare at an exceptionally wrong time.

Now that January 2000 has come without apparent major interruptions in computer services, the news media is reporting the Y2K bug "squashed" and appear to be insinuating that the problem was severely exaggerated. This is being done even in the face of hundreds of billions of dollars having been spent in remediation of important systems known to harbor flaws. The flaws would have made important applications such as financial systems or HIS's (hospital information systems) inoperative or erroneous.

The Loma Linda (Calif.) Medical Center offers a different perspective. An experiment conducted there after Jan. 1 is illuminating. Out of curiosity, IT personnel at this 653-bed hospital did nothing to upgrade an existing billing system that was being phased out. After the Y2K transition, financial transactions were fed into the old system. "Everything it produced was wrong; it had gotten completely confused," said CIO Bob Blades. "We're just grateful we upgraded everything else" (Modern Healthcare, 1/31/2000, p. 40).

This bizarre conclusion ("on the basis of not having experienced problems, we conclude there never was a problem") is a sad commentary on the ability of many to think rationally and make sound judgments on complex technological issues.

In another footnote, the organization that is the subject of this story also survived the Y2K transition, but at the cost of several years' needless delayed progress in clinical computing initiatives. Yet, the administration of this organization has been touting the Y2K effort as "a clear example of Unsurpassed Excellence." This statement comes at the very time the U.S. Government is considering legislation on the medical errors problem, which will undoubtedly result in the need for significant advancements in clinical IT. Such puffery, word hyperinflation and blind self-aggrandizement are characteristic of many hospital and MIS bureaucracies.